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Figure 29

Figure 30

The right-angle clamp is moved 1 cm toward the tip of the appendix. Just at the proximal edge of the crushed portion, the appendix is ligated (Figure 14) and a straight clamp is placed on the knot. A purse-string suture is laid in the wall of the cecum at the base of the appendix, care being taken not to perforate blood vessels where the mesentery of the appendix was attached (Figure 15). The appendix is held upward; the cecum is walled off with moist gauze to prevent contamination; and the appendix is divided between the ligature and clamp (Figure 16). The suture on the base of the appendix is cut and pushed inward with the straight clamp on the ligature of the stump to invaginate the stump into the cecal wall. The jaws of the clamp are separated, and the clamp is removed as the purse-string suture is tied. The wall of the cecum may be fixed with tissue forceps to aid in inverting the appendiceal stump (Figure 17). The cecum then appears as shown in Figure 18. The area is lavaged ...